Cannabis That Can Stop the Munchies? What is THCV?

.

.

.

MEDICAL MARIJUANA

.

Cannabis is legal in California for adult use as of January 1, 2018. This may be helpful to someone you know. It is a most important drug. Below you can find a few pointers that are basic to understanding what strains to try. Distributors are swamped with ten times as many buyers as last week, prices are doubled, taxes are very high, it is very expensive and you will need to test many strains before you find what works for you without making you stupid with euphoria that lasts 12 hours. Do be warned of turning the body into sofa-size obesity overnight. Munchies occur with high THC strains. To discuss below how to avoid that torture and still relieve pain or muscle spasm.

.

Horvath et al at Yale in 2015 found cannabis stimulates hunger and arousal in hypothalamic neurons. Here’s the YaleNews on the multi-authored work.

.

Horvath is the Jean and David W. Wallace Professor of Neurobiology and of Obstetrics, Gynecology, and Reproductive Sciences, director of the Yale Program in Cell Signaling and Neurobiology of Metabolism, and chair of the Section of Comparative Medicine.

.

To orient you in the quote below, cannabinoid receptor 1 (CB₁R) is one of the two known cannabinoid receptors in the brain. Others are located outside brain, throughout the body.

.

“The Pomc gene encodes both the anorexigenic peptide α-melanocyte-stimulating hormone, and the opioid peptide β-endorphin. Hypothalamic pro-opiomelanocortin (POMC) neurons promote satiety. Cannabinoid receptor 1 (CB₁R) is critical for the central regulation of food intake. CB₁R activation selectively increases β-endorphin but not α-melanocyte-stimulating hormone release in the hypothalamus, and systemic or hypothalamic administration of the opioid receptor antagonist naloxone blocks acute CB₁R-induced feeding.

.

Interesting. Low dose naltrexone, which is essentially long acting naloxone, may block munchies in humans? At what dose? Please comment if you take naltrexone 4.5 mg or 15 mg (anti-inflammatory doses) or 28 mg (weight loss dose) or 50 mg and above doses of naltrexone (high doses for addiction).

.

One strain that is better at stopping or reducing the munchies, and that is believed due to a cannabinoid in the strain called THCV. You can always do a search for THCV.

.

Cannabis is one of the few medications that can relieve some of the worst side effects of opioid withdrawal. Many patients find they need to use fewer opioid pills for pain or can stop them altogether; they need to use fewer muscle relaxants; and they can eat or sleep better if they use cannabis. Once cannabis became legal, many alcoholics were able to give up alcohol because their first preference is cannabis.

.

Get a low cost recommendation for medical marijuana in minutes at home from your mobile phone. The best source for recommendation is : HelloMD.

.

Cannabis may be legal in all states once tobacco companies toss some money at Congress. Could cannabis be related to the vow of Phillip Morris and a wave of big tobacco companies to stop selling cigarettes this year?

.

It is dreadfully expensive and heavily taxed. All states should adopt New Mexico’s law that allows healthcare insurers to reimburse patients who have paid for medicinal cannabis. Voters…

.

Cannabis is made by the body and the brain makes two of the endogenous cannabinoids. If is highly anti-inflammatory, and profoundly important mainly in the immune system but also in bone turnover. You have more cannabinoid receptors in your body than any other kind. It is as old as sponges, an ancient medicine.

.

A WORTHY READ

.

Mr. X – by Carl Sagan who describes his experience with marijuana at length and used it creatively for decades opening his brain to experiences he was otherwise not oriented to at all.

.

.

MUNCHIES

.

Fear the munchies. Cannabis, medical marijuana, can cause the munchies, an overwhelming desire to eat nonstop, usually all the most high calorie things your desperately fevered brain can dream of cramming in.

.

Certain strains of cannabis can be life saving for those who have loss of appetite from conditions such as cancer, HIV/AIDS, depression, inflammatory conditions, etc. But the munchies can be disastrous when you cannot afford to gain weight due to pain or disability or simply wish to develop an important standard to maintain best health which means good lean body weight. The best way to reduce inflammation is to avoid obesity, avoid sugar, avoid diabetes, heart attacks, strokes. Remember inflammation is the root cause of 90% of the conditions we die of: diabetes, cancers, Alzheimer’s, Parkinson’s, autoimmune disease, atherosclerosis, etc.

.

Those with an eating disorder should scrupulously avoid those strains that are highly rated for helping anorexia, loss of appetite.

.

CHOOSE STRAINS THAT STOP THE MUNCHIES

STRAINS WITH HIGH THCV  OR HIGH CBD 

.

If needing high THC for pain or appetite, for example, then a strain with high THC and high THCV is Durban Poison. Read in detail about strains on leafy.com using the search function and it will find dispensaries in your area.

.

If low THC is all you need, then Leafly discusses high CBD strains with low THC currently available. Google it or ask the dispensary.

.

I am not going to do more than mention these three cannabinoids: THC, CBD, THCV. You can google them but do glance at my outdated 2009 cannabis website – CBD has vastly changed since then, available even at farmer’s markets and nutrition departments of groceries.

.

The cannabis plant has 400 chemicals of which about 86 are known cannabinoids but we focus on just a few and hybrids have been bred to display many qualities and various percentages of cannabinoids.

.

THC

.

THC, tetrahydrocannabinol, can cause euphoria and is the principal psychoactive ingredient useful for pain, depression, appetite, multiple sclerosis, fatigue, stress, and many conditions including just to have fun, be giggly or creative. For the California Medical Board, a strain with 18% THC is considered high, but some strains such as Holy Grail have 27% or more THC. Some strains are noted for causing more anxiety or paranoia due to THC content. It is widely said THC is necessary for pain relief but… see CBD below.

.

CBD

.

CBD, cannabidiol, a non-psychoactive cannabidiol that blocks the psychoactive component of THC so that you may be able to mix with THC in order to use a stronger dose of THC for the underlying condition —  find your best ratio of CBD to THC. Or use 100% CBD. Among strains of flower sold at dispensary, I’m not sure what % CBD

.

Some people are highly sensitive to THC (paranoia, panic attacks, anxiety) and cannot use any THC or only very tiny amounts of THC with higher percentage CBD.

.

Some use pure 100% CBD which is said to be useful for Crohn’s Disease, PTSD, multiple sclerosis and certain seizure disorders, the severe childhood Dravet Syndrome. There is a recent single report of an adult who failed all anticonvulsants and responded to CBD alone. I have seen a patient with depression after 2 years of severe disability from 4 major chronic pain conditions, surprisingly all pain 100% relieved by CBD. It is widely said that THC is essential for pain relief but for this case not needed.

.

Some dispensaries will mix liquid CBD:THC in ratios of 15mg/mL CBD to 0.1 mg/mL CBD all the way up to ratio of 15:15 or more. Use topically, under tongue or swallow. One patient dilutes and uses topically. Very expensive!!! It is the only thing helping his extremely painful autoimmune neuropathy.

.

THCV

.

Leafly discusses ten strains that will not make you (as) hungry. 

.

After discussing high CBD strains, then turn to high THCV:

.

High THCV Sativa Strains

“By now you know what THC and CBD is, but you may not be familiar with the less ubiquitous THCV, a related chemical that suppresses appetite. While most strains on the market today tend to test anywhere between 10-20% THC, what’s considered a high THCV content might only hit a high-water mark of 5%. THCV tends to be more abundant in sativa strains, and it’s possible you’ve noticed that sativas tend to provoke hunger less than indica strains. The unique metabolic effects of THCV even have researchers considering its utility in treating obesity and diabetes.”

.

Durban Poison is the name of the strain with highest THC and THCV, and a good profile detailed on Leafly: Maximal effect is Energetic > happy > uplifted >> focused >> euphoric. Not everyone may have all these effects.

.

Always check Leafly’s negatives for each strain and look at the bar graphs — how severe are the side effects? Note that always worst is dry mouth. Half as bad are dry eyes for this strain – at least not as bad as dry mouth; and much lower in incidence is dizzy, anxious, paranoid. Overall a very good profile for a high THC strain.

.

RISKS

.

Note, those with Sjogren’s Syndrome who have dry eyes are at risk for corneal transplants and who have dry mouth are at risk for all teeth crumbling, so choose and treat accordingly.

.

Cannabis can increase pulse and blood pressure which can be a risk of heart attack and stroke for any age. It is especially likely if you are naive to the drug, i.e. have never used it or have not introduced it to your system for decades. Check blood pressure and pulse before use and after you feel the peak effect.

.

The youngest person I found on the internet who died of heart attack caused by cannabis was a healthy 17 year old male, possibly a false report, but cardiac arrhythmias can be fatal and there are undiagnosed cardiac conditions in young athletes who may be likely to use cannabis.

.

Cannabis can interfere with memory.

.

The adolescent developing brain may be vulnerable to harmful effects.

.

HOW TO USE IT

.

Vaporize it. Avoid 4 toxins. Rapid onset, short duration of effect.

If smoking, you will inhale 4 major toxins.

Use under tongue or topically on skin.

.

If you swallow cannabis, you will not feel effect for 90 to 120 minutes so allow 2 hours before you add more or you may seriously overdose. Duration of effect may be 4 to 12 hours or more – overdosing can last days.

.

5 mg oral THC may be too much for a starter dose for some people, but may be average for many, and some may need 10 mg. But heavy users need far, far more: TOLERANCE DEVELOPS!!! Money down the drain. Use only as much as you need or you will develop tolerance and require more frequent and higher and higher doses to reach same effect. That can be unaffordable for the average middle class person. 

.

And yes, it may appear in urine for 30 to 60 days, possibly more.

.

Cannabis is still a schedule I drug. The Emperor has no clothes. Do not take it onto planes or attempt to mail it.

..

Do read more about it on my cannabis website linked above. It is a drug. You will benefit from learning how to use it.

.

.

.

.

..

.

.

.

.

.

.

.

The material on this site is for informational purposes only.

.

It is not legal for me to provide medical advice without an examination.

.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~

Comments are welcome.

This site is not for email, not for medical questions, and not for appointments.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

.

Please IGNORE THE ADS BELOW. They are not from me.

.

.

.

.

.

..

..

.

.

.

 

 

.

 

.

.

.

.

.

.

.

.

 

Selenium Supplement

.

.

.

Selenium Toxicity

.

Almost every American is taking supplements without knowing the reactions they are causing. Most do not know the ingredients they take daily for years, then they see neurologists for muscle weakness and neuropathy. 90% of the causes of neuropathy are unknown – selenium is one.  Muscle weakness, another. Doctors don’t ask to review labels on supplements.

.

The biggest issue (no pun) is insulin resistance that leads to diabetes and obesity.

.

.

 

From Memorial Sloan Kettering Cancer Center Herbs & Botanicals

.

“Excessive intake of selenium induces hepatic insulin resistance through opposite regulation of ROS [Reactive oxygen species].”

.

Adverse reactions:

.

“Oral consumption of 10 g of sodium selenate supplements for treatment of prostate cancer resulted in the death of a 75-year-old man.”

.

Chronic selenosis (doses greater than 1000 µg/day): muscle weakness, fatigue, peripheral neuropathy, dermatitis, nail and hair changes/loss, garlic breath/body odor, irritability, growth retardation, hepatic necrosis” (death).

.

Toxicity: “Consumption of gram quantities of selenium can cause severe gastrointestinal and neurological disturbances, acute respiratory distress syndrome, myocardial infarction and renal failure.”

.

.

.

.

.

.

.

.

The material on this site is for informational purposes only.

.

It is not legal for me to provide medical advice without an examination.

.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~

This site is not for email and not for appointments.

If you wish an appointment, please telephone the office to schedule.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

..

Please IGNORE THE ADS BELOW. They are not from me.

.

.

.

.

.

NFL – Prevent &Treat Chronic Traumatic Encephalopathy, CTE – Opioids Blamed Wrongly

.

 

. 

.

Crowdfunding Needed

.

.

Prevent and Treat

.

Chronic Traumatic Encephalopathy

.

C.T.E.

.

Opioids Wrongly Blamed

.

Leagues may have known about this technology since 2002 publications

.

Football players have demonstrated ability to influence others

and raise money for important medical causes.

.

This is not about class action law suits.

.

This can be imaged early and likely treated.

.

It’s about science and bringing medicine into the 21st century.

.

A paradigm shift began with the discovery

of the innate immune system by internationally recognized scientists in 1991.

.

The clock has been turned off.

.

We can change this now.

.

Funding is needed for internationally recognized leaders to continue this work.

.

 

.

.
The tragic deaths of former NFL football players from repeated concussions has led to brain damage and death from Chronic Traumatic Encephalopathy (CTE). Suicide profoundly shocks us when many players like Junior Seau at age 43 and now Tyler Sash, die at age 27. He is the youngest found to have such extensive brain damage, as bad as that seen in Junior Seau. So much can be done with state of the art science now that has been ignored.

.

Disclosure: I was asked by a research institute if I would evaluate retired NFL players. I chose not to do that so that I might be free to post unbiased information that is not subject to being manipulated by either side in the ongoing appeals for compensation that must be going on with the NFL for $70 million. Tragic that this is such a fight. Even more tragic, this may be diagnosed early and treated.

.

Pearls

.

Fear of compensation claims after concussion injury prevents imaging of football players and veterans early, while still treatable, before severe changes and death.

.

Fear of compensation claims has prevented decades of research funding by internationally recognized scientists. Could politics at NIH & the VA have turned off funding for veterans with pain and with concussion blast injuries? Does cancer and heart disease forever lock up all the research money and now it shifts to stem cells?

.

It is inaccurate to say that CTE cannot be diagnosed except after death at autopsy.

.

PET scan imaging of glia can show changes early, while alive.

.

The ligand PK1195 must be used for PET scan to image glia, available for years in Australia, not yet in America.

.

FDA approval must be obtained for the ligand PK1195 before it is used to  image glia in the United States.

.

CTE can be diagnosed early.

.

CTE is likely to be treatable.

.

Internationally distinguished scientists have shown reversal of complete paralysis in rat models of multiple sclerosis in 2010, a so called “degenerative” neurological disease.

.

Intractable pain and treatment resistant depression can be put into remission with glial modulators. Surely CTE and other neurological diseases can be approached with scientifically recognized mechanisms and treatments – even if doctors are not aware of the paradigm shift and how to modulate neuro-inflammation. See years of posting on this site since 2009 based on the most important finds in the field of neuroscience for more than 100 years: the innate immune system, glia, neuro-inflammation, and ability to use glial modulators, to modulate intractable conditions that are known to lead to suicide and/or death.

.

Paradigm shifts in all fields including medicine, fail to be recognized.

.

.

CTE gives opioids a bad name and misled Taylor Sash and likely others from the diagnosis of CTE that caused years of severe forgetfulness and behavior changes. He may have chosen suicide by opioid.

 

 

 

FACT:

.

Trauma such as concussion or infection or stroke triggers inflammation in the brain:  “cytokine storm”

.

Inflammation kills brain cells

.

Inflammatory cytokines (inflammation) are produced by glia that has been activated by trauma or other causes such as infection, stroke, etc.

.

Activated glia produce neuroinflammation and cell death.

.

Inflammatory cytokines produce pain and “degenerative” neurological and psychiatric disorders including dementia, depression, anxiety, delirium and death.

.

Neuro-inflammation in brain has been found in teens with early signs of schizophrenia, in rats made depressed, and rodents with chronic pain.

.

Glia have been detected in life, in vivo, with PET scan imaging, by internationally-recognised radiologist working at Imperial College London, now based in Australia.

.

PET scans require a ligand, PK1195, approved for years in Australia – must be approved by FDA in the United States before it can be used here.

.

There is good clinical data and publications in animal models to show that damage in brain and spinal cord produced by activated glia can be reversed.

E.g., In 2010, total paralysis has been completely reversed in a rat model of multiple sclerosis by internationally-recognised glial researcher who, in 1991, transformed the understanding of glia that comprise 85% of the brain, since then known to be the innate immune system.

.

Publications have shown that patients with major depressive disorder and patients with chronic low back pain have memory loss and brain atrophy.

.

Opioids cause pain by stimulating production of inflammatory cytokines that are known to damage neurons in brain and spinal cord – and must be tapered off. We have better treatment for pain.

.

Insurance carriers routinely deny payment for recognized medications and procedures to relieve pain.

.

CDC is planning a nationwide experiment to radically limit opioids.

.
Treatment with glial modulators that reduce neuroinflammation has been shown clinically to relieve treatment resistant major depressive disorder, PTSD, bipolar depression and intractable pain. They are neuroprotective.

.

We need to be able to flag players off the field early and intervene with treatment such as glial modulators either before, during or after repeated injury.

.

.

GOALS

.

1.  PK1195, a ligand for PET scans, must be tested and approved by FDA. Approval is mandatory for all medications or substances injected into vein or body.

.
It simply “tags” the PET scanner to image glia, the cells of the innate immune system that are activated by trauma, infection, stroke, etc.

.

2. Do serial PET scans using PK1195 to image glia in NFL players and veterans after blast injury.

.
Trauma from concussion is causing cytokine storm, killing brain cells –> ultimately end stage dementia, anxiety, depression, suicide

.

3. Flag that player off the field. Follow glial changes during treatment to determine if able to return or if permanent, but prior to end stage damage.

.

4.  Treat with glial modulators preventively, early, middle, and/or late

.

.

.

This subject will be continued. My apologies for lack of time to delete and edit. Days pass by quickly to post brief comments. Time is limited. Please send comments, below.

.

 

.

.

.

.

.

.

.

.

The material on this site is for informational purposes only.

It is not a substitute for medical advice,

diagnosis or treatment provided by a qualified health care provider.

Relevant comments are welcome.

If any questions, please call the office to schedule an appointment.

This site is not email for personal questions.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

.

.

.

.

Please be aware any advertising on this free website is

NOT advocated by me and NOT approved by me.

.

.

.

.

.

.

.

.

.

 

 

 

Radical experiment in managing pain without narcotics – Validation of years of work

.

Read this story in the New York Times Business Day, May 10, 2014.

 

.

It is the story of one veteran who had severe injuries. His wife now says when she sees other patients: “I can go in there and I can immediately spot people that are on narcotics or on drugs.”

 

.

A Soldier’s War on Pain

.

.

Many thanks from my heart to Barry Meier for his research into these rare pain specialists who are managing pain without narcotics, and the story of how this veteran did it.

.

This validates so much of the work I’ve been toiling over since the turn of the century. This has nothing to do with blame. There is a whole new paradigm to the understanding of treating pain. But the article mentioned only those things my patients have failed, that were done before use of opioids. Physical therapy alone dates back to Greek culture and Hippocrates’ influence as the father of Western medicine and in Europe during the 1500’s. But another point was made and is important to emphasize: these therapies don’t work while someone continues taking opioids.

.

Where are we now and what are the questions?

.

-Only a few doctors are mentioned. We need more.

-Physicians are taught the first thing: Do no harm. But we are in a very difficult place right now. We are taught to use opioids. Little attention has been paid to research on how to treat patients once off opioids, after they have failed gabapentin, Lyrica, Cymbalta, opioids, Elavil.

-Patients don’t know that when asking for more opioids, they are actually creating more pain.

-There is less pain when you taper off opioids. That alone is often enough to help, but often more must be done.

-Who does better with a new approach?

-Insurance companies must be taught not to tie doctor’s hands with denials.

-Do we need to allow PA’s and NA’s to write their own opioids without doctor’s supervision?

-Or do we need to teach everyone, doctors and patients included, how to treat pain without opioids?

-None of us has the data that gives us greater certainty. Until then trillions of dollars are wasted creating disability and pain unknowingly.

-No I am not taking away grandmum’s small dose that she has been on for years and has been shown to improve function.

-Acute pain definitely and usually requires treatment with opioids. But chronic pain? How long do we prescribe opioids in the acute situation before we taper?

.

Monster in the system – personal doctor ratings

Translation: job and hospital ratings – by the insurance system and the internet’s phoney doctor “ratings” — all those ratings partly depend on giving opioids and that colors the patient’s opinion of the doctor.

.

Doctors who push opioids are more highly rated by patients. Is that what we want as a society?

.

 Patients can’t be faulted.

How can they know better?

.

Doctors do what they are trained to do, unaware that the opioids they prescribe actually cause more pain,  reinforcing the demand to give more opioids.

.

 

.

I see better pain relief without opioids

.

I will add much more on this page in the next few days, and even later adding remarkable case reports, and covering other medications seldom used, often compounded, but I wanted to get this out urgently. This is such a vast area. We all need to learn from those who are doing this work.

 

Low dose naltrexone (LDN), novel anti-inflammatory treatment for chronic pain

.

.

A review of the clinical use of low dose naltrexone appeared today by Younger, et al. from Stanford (see e-Pub below).

.

Naltrexone is one of the most important medications I have prescribed, alone or in combination with other medications for intractable chronic pain and/or treatment resistant Major Depressive Disorder or Bipolar Disorder. It has been most extensively used anecdotally and off label since 1985 for treatment of Multiple Sclerosis.

.

Naltrexone acts on two receptors in the central nervous system: (1) the opioid receptor and (2) the TLR4 receptor on glia.

..

(1) The opioid receptor is blocked by naltrexone. Naltrexone cannot be given to someone who uses opioid analgesics because it would cause a severe or unpleasant opioid withdrawal reaction. But in low dose, it can do better than opioids for relief of intractable pain. I would like to see it tried for pain, alone or in combination, before any opioid is started. And if on opioids, taper slowly off opioid in order to see how superior low dose naltrexone is. See case reports elsewhere on this site.

.

Low dose naltrexone is quite different than its use in high dose where it is FDA approved for addiction to alcohol and opiates. Naltrexone reduces craving. However, in high dose, it blocks the endorphins, the opiates that your brain produces, thus causing pain and depression.

.

(2) The TLR4 receptor was discovered by Bruce Beutler, MD, working at Scripps Research Institute. He won the Nobel Prize in 2011 for that profound work. The TLR4 receptor is found on the microglial cell in the central nervous system. The microglia far outnumber nerve cells in the brain and spinal cord. I discussed a small portion of the vast science of the importance of glia, your innate immune system and inflammatory cytokines, here. This research on glia, the innate immune system, is new, largely in the last 10 to 15 years.

.

One of the mechanisms by which opioids create pain is that opioids trigger glia to release pro-inflammatory cytokines, i.e. opioids create a neuroinflammatory response in a manner similar to endotoxin from bacteria. Opioids upset the balance of pro- and anti-inflammatory cytokines to create more pain. Naltrexone does the opposite by its action on the glial TLR4 receptor reducing pro-inflammatory cytokines and relieving pain.

.

Inflammation kills! Glia and/or the inflammation produced by glia are involved in many pathological processes: Alzheimer’s, Parkinsons, ALS, MS, chronic pain, depression, autoimmune disease, cancer, atherosclerosis. The TLR4 receptor is necessary for death or destruction of oligodendrocytes and myelin, as occurs in multiple sclerosis. Does that mean low dose naltrexone may play a role in modulating these conditions?

.

See reviews by distinguished Professor Linda Watkins, PhD, and Mark Hutchinson, PhD, on glia, neuroinflammation and the neuroimmunopharmacology of opioids. Besides glia, Watkins and Hutchinson have recently discovered Toll-like expression of neuronal receptors in pain states.

.

For access to articles on glia, cytokines and the TLR4 receptor, see the RSD Syndrome Association library of key publications. And donate to them. They have supported key research in pain when NIH gave less than half of 1% to pain research in 2006, now far less since the deadly the recession of 2008 and the ever threatened fight over funding the national debt.

.

Being interested in glia, and treating so many patients with Major Depressive Disorder who had failed other treatments, I did a review of depression and glia and found the same increase in pro-inflammatory cytokines in depression that are found in chronic pain. Since low dose naltrexone is anti-inflammatory, i.e. it modulates or resets the balance of pro-inflammatory and anti-inflammatory cytokines that are produced by glia, I felt it important to try in Major Depressive Disorder. Besides, I had seen its profound effect on so many different forms of intractable pain for many years. Use of LDN has never been associated with toxicity and rarely any side effects.

.

My patient had severe suicidal ideation with Major Depressive Disorder for more than three months, unchanged after treatment at a psychiatric center where she had stayed almost four weeks. She began with 4.5 mg in the office and 25 minutes later, on the drive home, her appetite returned! She walked in the house and her dad was astonished – she no longer walked like she was 105 years old! She had the energy to do her laundry and cook for the family for the first time in more than three months.

.

Another person for whom I prescribe naltrexone for Major Depression, wrote to me saying Massachusetts General, a Harvard Hospital, was starting clinical trials of low dose naltrexone for Major Depressive Disorder. Other new clinical trials of low dose naltrexone can be found here.

.

Jared Younger, PhD, from Stanford first published on the use of naltrexone in fibromyalgia – see my discussion here.

.

Today in PubMed, ahead of print, Dr. Younger et al. publish a review of low dose naltrexone, a glial modulator.

.

.

The use of low-dose naltrexone (LDN) as a novel

anti-inflammatory treatment for chronic pain

.

Authors  Younger J, Parkitny L, McLain D.

Journal

Clin Rheumatol. 2014 Feb 15.  [Epub ahead of print]

Affiliation

Abstract

Low-dose naltrexone (LDN) has been demonstrated to reduce symptom severity in conditions such as fibromyalgia, Crohn’s disease, multiple sclerosis, and complex regional pain syndrome. We review the evidence that LDN may operate as a novel anti-inflammatory agent in the central nervous system, via action on microglial cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone’s better-known activity on opioid receptors. As a daily oral therapy, LDN is inexpensive and well-tolerated. Despite initial promise of efficacy, the use of LDN for chronic disorders is still highly experimental. Published trials have low sample sizes, and few replications have been performed. We cover the typical usage of LDN in clinical trials, caveats to using the medication, and recommendations for future research and clinical work. LDN may represent one of the first glial cell modulators to be used for the management of chronic pain disorders.

.

.

.

The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

.

.

.

RSD/CRPS, Multiple Sclerosis, LDN & Ketamine

………

.

It is rare for me to see a patient who is not complex.

They have failed so many treatments for so many years before they call.

.

This is the report of a lovely woman in her early 70’s with progressive Multiple Sclerosis for 30 years and paraplegia that has forced her to use an electric scooter the last 5 years, and power wheelchair the last 2o years. Because of total paralysis of the right lower limb, she fell and shattered her femur, the thigh bone, in August 2009. Tragically, and all too often, the surgeon failed to diagnose Complex Regional Pain Syndrome [CRPS], even failed to visit her in the hospital. CRPS increased the fatigue she had already had from Multiple Sclerosis.

.

Thankfully a physical therapist suggested the diagnosis.

.

Why is pain management not a required subject for physicians?

.

I have written elsewhere that the American Pain Society discovered that our National Institute of Health, NIH, devotes less than half of 1% of their research dollar to pain research. Of 28 NIH institutes, none for pain, three for addiction. This will not change soon. The only hope is that RSDSA.org will succeed in collaborating with all pain organizations, groups with dystonia, chronic fatigue in order to give a voice and research dollar to advances.

.

Before seeing me in September, she had 11 sympathetic blocks with no benefit.

.

Does it make you wonder why 11 were done?

.

How does insurance authorize 11 when 10 had no benefit? I have just learned that a doctor must indicate at least 50% relief before another will be authorized. That explains it.

.

Then she was given opioids including tramadal and Butrans patch which rendered her a “zombie,” sedated, poor memory, unable to function. She tried 4 or 5 treatments of Calmare with no benefit but was advised she needed a clear neural pathway for it to work. That was not possible due to the Multiple Sclerosis.
.

Lyrica caused severe edema. Gabapentin 1400 mg/day caused weight gain, increased her appetite  more than usual, but she remained on it. She craves sweets more than usual, at times uncontrollably. Perhaps it can be slowly tapered now. Advil 600 mg gave some benefit but caused ulcers that required Nexium.

.

Since her initial visit a few weeks ago, she became 60% better during her two week stay.

.

I will highlight only two of the new medications started.

.

It may also be said that opioids are not the answer.

Opioids may perpetuate pain.
They may produce paradoxical pain or opioid induced hyperalgesia or windup.

They may block the effect of ketamine and other adjuvants that would otherwise lower pain.

.

.

Of importance is that she was not able to tolerate clothing on her right lower limb for three years, not even a sheet, and now she is able to sleep through the night without pain for the first time in three years and able to wear a skirt. This allows her to go out with family to restaurants and even to enjoy shopping with her daughter. Her dose of ketamine is very small relative to most of my patients and she uses it only once or twice a day since most of the new medications have brought her pain down.

.

At her first visit one month ago, she rated pain from 6 to 8 on a scale of 10, average 7/10. Now 60% better, ranging from zero to 7, average 4. Yes zero pain, sleeping through the night without pain and waking without pain. She had not been able to tolerate touch to the right thigh or foot and would pull her skirt above the thigh, removing her shoe.

.

Now she indicates pain continues to improve.

.

Of interest, despite an abundance of concern that low dose naltrexone [LDN] may flare her Multiple Sclerosis, we were easily able to increase the dose to triple what is usually called “LDN.” This did not flare her condition and may be one of the most effective medications she is taking for pain.

.

What is LDN?

.

The FDA has sanctioned its use in the USA only in doses of 50 to 400 mg for addiction to opioids and alcohol.

.

Low dose naltrexone [LDN] is a fascinating medication. It has been used in low dose in persons with Multiple Sclerosis since 1985 when a Harvard trained neurologist in New York City, Dr. Bihari, first discovered that it relieved all disability in some patients with Multiple Sclerosis and prevented recurrent attacks. Since then, doctors in Scotland, where they have the highest incidence of Multiple Sclerosis, find that one of the earliest signs of recovery in this population is relief of neurogenic bladder. It is said that persons with Multiple Sclerosis must remain on LDN for 1.5 years before they might fully assess its value.

.

 Multiple Sclerosis may be flared unless very small doses of LDN are used.

.

Many with Mulitple Sclerosis cannot tolerate more than 2 or 3 mg, perhaps due to spasticity. There is a great deal of dogma on the web about its mechanism, dosing and timing for off label use. Use the search function on this site to review the prior discussions I posted on LDN, MS, CRPS.

.

Naltrexone is a glial modulator.

.

What’s that?!

.

By serendipity, four years ago I discovered naltrexone in low dose may relieve chronic intractable pain. I had been using it for perhaps eight years in microgram doses but I found in milligram doses it is even more profound.

.

The mechanism of naltrexone and a wee bit of glial research is discussed here. The Nobel Prize was awarded last year for the discovery that these glia are your innate immune system. They are profoundly important in many diseases including chronic pain, Major Depression, Multiple Sclerosis, Alzheimers, Parkinsons Disease, ALS, Autism. They produce inflammatory cytokines that lead to inflammation.

.

Now that she has been home for two weeks, on a number of medications that I started, not just the ketamine and LDN, I hope she will comment on her experience and her progress since flying back to the east coast after her brief visit here.

.

It is often essential to taper off opioids to allow other medication to work.

.

I feel she was able to benefit from these low doses of medication because she tapered off all opioid medication prior to her visit, thus allowing her system to recover and respond to these medications. We will know more in the next few months as she slowly titrates up on some of the medications that were started.

.

Next year on her return, we may be able to withdraw some of the medications depending on how well she is doing.

.

Finally, ketamine does cause her to have brief side effects. Her husband likens the effect the same as half a glass of wine: “She’s really cute.” Thankfully, most people have no side effects and if they do, they rarely last more than 20 minutes.

.

She sends an update below, 80 to 90% better. Hopefully this will continue to improve over the next months as she slowly increases the medication we started. And ketamine has an additive effect in some. It is anti-inflammatory.

.

.

~~~~~

The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

.

Please understand that it is not legal for me to give medical advice without a consultation.

If you wish an appointment, please telephone my office or contact your local psychiatrist.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

.

.

.

Exercise, a natural pain reliever, can decrease pain, fatigue, stiffness & need for drugs

~

What you can do

“Moving is the best medicine”

~

For headache and neck and shoulder pain

As reported in the leading headache journal, Cephalalgia, office workers with headache, neck and shoulder pain took part in an education and relaxation program in an Italian study over eight months. They kept diaries and did posture and relaxation exercises every two to three hours. Compared to a control group, headache and neck and shoulder pain decreased by more than 40% and use of analgesic drugs was cut in half.

~

For Arthritis Pain

Physical activity is actually a natural pain reliever.

~

A  study published in Arthritis Care and Research concluded that regular exercise is effective in significantly improving arthritis pain.

~

The in-depth study looked at the effectiveness of the Arthritis Foundation Exercise Program – formerly known as the People with Arthritis Can Exercise (PACE) program – to reduce pain and stiffness by keeping joints flexible and muscles strong.

~

Participants reported a decrease in pain and fatigue, an increase in upper and lower extremity function, and an increase in strength after participating in the basic 8-week exercise program. Also, participants who continued the exercise program independently, beyond 8 weeks, sustained improvement in reduced stiffness.

~

“The study showed that the exercise program is suitable for every fitness level, even inactive older individuals,” said author of the study Leigh Callahan, PhD, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill. “Many people believe the myth that exercise exacerbates their symptoms. The truth revealed in the study is that symptoms improved with exercise.”

~

Exercising for joint health is different than exercising for heart health. People living with arthritis don’t have to sweat to achieve success. The basic 8-week Arthritis Foundation Exercise Program consists of low-impact routines with gentle range-of-motion movements that can be done while sitting or standing.

~

“Even minor lifestyle changes like taking a 10-minute walk 3 times a day can reduce the impact of arthritis on a person’s daily activities and help to prevent developing more painful arthritis,” explains Patience White, MD, chief public health officer of the Arthritis Foundation. “Physical activity can actually reduce pain naturally and decrease dependence on pain medications.”

~

The Arthritis Foundation Exercise Program is offered at basic and advanced levels and is available throughout the country in many convenient community-based settings. A detailed listing of classes in local areas can be found on the Arthritis Foundation’s Web site at http://www.arthritis.org.